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GERIATRIC EMERGENCY PREPAREDNESS AND RESPONSE (GEPR)

WEBINAR SERIES 2015 STRENGTHENING PREPAREDNESS AND RESILIENCE CAPABILITIES

IN VULNERABLE OLDER POPULATIONS SESSION ONE

Sponsor: The GEPR Collaborative

Host: Stanford Geriatric Education Center Webinar Coordinator: Melen McBride, PhD, RN, FGSA

This project is/was supported by funds from the Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under UB4HP19049, grant title: Geriatric Education Centers,

total award amount: $384,525. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPr, HRSA, DHHS or the U.S. Government.

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EMERGENCY PLANNING CHALLENGES FOR VULNERABLE OLDER PERSONS

WITH FUNCTIONAL AND ACCESS NEEDS (FAN)

Elizabeth “Betty” Shiels, PhD-C, LCSW Institutional Director, Ohio Valley Appalachia Region GEC

Director, Kentucky Emergency Preparedness for Aging & Long Term Care Program,

Kent School of Social Work, University of Louisville

April 8, 2015

April 18, 2013 2

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Betty Shiels, MSSW, LCSW, PhD-C

Betty is the Institutional Director of the Ohio Valley Appalachia Regional Geriatric Education Center at the University of Louisville, Kent School of Social Work. She has a Masters of Science in Social Work and is completing her PhD in Social Work at the University of Louisville.

She is the Principal Investigator for the Kentucky Department for Public Health Emergency Preparedness for Aging Program at the University of Louisville in partnership with OVAR/GEC at the University of Kentucky. She has years of experience working with KY long-term care for the western half of the state in conjunction with the KY Hospital Preparedness Program.

Her work is focused on emergency preparedness for long term care providers in Kentucky. She is co-author of the KY All Hazards Long Term Care Planning and Resource Manual that was designated as a 2010 national best practice guide by US Department of Health and Human Services (USDHHS), Office of the Assistant Secretary for Preparedness and Response (ASPR).

She serves on the Board of the National Association of GECs and the National Association for Geriatric Education. In February, Betty was appointed to Chair the Disaster and Aging Interest Group of the Gerontological Society of America.

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Learning Objectives

Upon completion of the session, participants can: 1. List at least three new information about functional and access needs in older persons; 2. Identify public health challenges to community resilience; and 3. Identify various strategies to engage the FAN population.

KY Functional and Access Needs Definition

• Individuals with needs which necessitate assistance before, during, and after an emergency are considered to be at risk.

• At-risk individuals may have disabilities, limited language proficiency or

medical disorders that affect their ability to effectively navigate a disaster or emergency.

• Persons with functional or access needs may be illiterate, transient, transportation disadvantaged, pharmacologically dependent and include children, older persons and pregnant women. They may have needs in communication, medical intervention, independence maintained with assistance, supervision and transportation.

Concerns of Older Persons (OVAR Focus Groups)

Notification

Independence

Chronic Health Issues

Medications

Isolation

Mobility

Memory

Sensory Changes

◦ Hearing, Sight,

◦ Smell, Touch, Taste

Mental Health Issues

Transportation

Financial Limitations

Bureaucracy

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Concerns of Agencies

◦ Line of Command ◦ Emergency Support ◦ Shelter-in-Place or Evacuate ◦ Securing Supplies & Equipment ◦ Transportation ◦ Heating and Cooling ◦ Functional and Access Needs Sheltering ◦ Staffing ◦ Interruption of Services ◦ Continuity of Operations

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Older Persons: High Risk in an Emergency

Altered immune function

Higher risk of infectious illness

Reduced response to antibiotics

Atypical presentation of disease

Chronic medical conditions

Greater risk of pneumonia

(40-150 times)

Memory disorder/Dementia

Hyper/hypothermia

Multiple medications

Sensory Changes

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Older Persons: High Risk in an Emergency

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Need assistance with activities of daily living

Use of portable oxygen & other medical supplies

Use of wheelchairs, walkers, canes, assistive devices

Anxiety about leaving familiar surroundings

Decreased rebound after emergency

Delayed onset of Post-traumatic Stress Syndrome

Language/cultural influences

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Definition-----KY Functional and Access Needs Population

• Individuals with needs which necessitate assistance before, during, and after an emergency are considered to be at risk.

• At-risk individuals may have disabilities, limited language proficiency or medical

disorders that affect their ability to effectively navigate a disaster or emergency.

• Persons with functional or access needs may be illiterate, transient, transportation disadvantaged, pharmacologically dependent and include children, older persons and pregnant women. They may have needs in communication, medical intervention, independence maintained with assistance, supervision and transportation.

Definitions----- California Office for Access and Functional Needs

Identification of People with Access and Functional Needs Functional Needs Population (formerly Special Needs Population) - Populations whose members may have additional needs before, during and after an incident in functional areas, including but not limited to:

maintaining independence,

communication,

transportation, supervision, and/or

medical care. Individuals in need of additional response assistance may include:

those who live in institutionalized settings,

older adults, children,

those from diverse cultures,

those who have limited English proficiency or are non-English speaking, or

those who are transportation disadvantaged. (National Response Framework Glossary http://www.fema.gov/emergency/nrf/glossary.htm) (2009)

Definition----National Council on Disabilities In disaster management activities it is important to think about

disability broadly. Traditional narrow definitions of disability are not appropriate. The term disability does not apply just to people whose disabilities are noticeable, such as wheelchair users and people who are blind or deaf.

The term also applies to people with heart disease, emotional or psychiatric conditions, arthritis, significant allergies, asthma, multiple chemical sensitivities, respiratory conditions, and some visual, hearing, and cognitive disabilities. (NCD)

“Finally, when the needs of people with disabilities and others with access and functional needs are included and accommodated in planning and services, many more people will benefit from accessible communications—an estimated 50 percent of the population (Kailes, 2007, p. 236).”

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Implications of New Definitions

Expands those who are covered for ADA compliance in disasters Applies to 50% of older population Changed the perspective of community sheltering Shift away from Community shelters, Special Needs shelters and

Medical Needs shelters to Community shelters and Medical Needs shelters

Places greater responsibilities on Community shelter operators, incl. the American Red Cross and Faith-Based or Mom and Pop shelters

Adds the liability of compliance, especially informal shelters

Implications of New Definitions

Greater need for a wide variety of partners

Greater need for sheltering-in-place planning

Greater need for neighborhood planning

Who are the Most At-Risk Older Persons?

Long-Term Care Residents

Persons living in Assisted Living

Persons living in underserved neighborhoods

Persons living in Assisted Housing (HUD 202 and 811 programs)

Persons receiving Medicaid 1915 Waivers

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Medicaid Waiver Program – Home and Community-Based Services

Medicaid 1915(c) Home & Community-Based Waivers “The 1915(c) waivers are one of many options available to states to allow the provision of long term care services in home and community based settings under the Medicaid Program. States can offer a variety of services under an HCBS Waiver program. Programs can provide a combination of standard medical services and non-medical services. Standard services include but are not limited to: case management (i.e. supports and service coordination), homemaker, home health aide, personal care, adult day health services, habilitation (both day and residential), and respite care. States can also propose "other" types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community.” http://www.medicaid.gov/medicaid-chip-program-information/by-topics/waivers/home-and-community-based-1915-c-waivers.html

HCBS Growth 2001-2011

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HCBS Expenditures

HCBS Recipients

49% represented the aged and aged or disabled,

40% represented persons with I/DD,

6% represented persons with physical disabilities

5% represented children who are medically fragile or technology-dependent (38,950), individuals with TBI/SCI (17,043), individuals with HIV/AIDS (13,451), and individuals with mental health disabilities (3,549).

Kaiser Family Foundation

HUD-Funded 202 and 811 Program Housing

Almost 400,000 units across U.S. Means-tested at significant levels below poverty with many at 200%

below poverty Greater average annual length of stay Older persons move in to stay while younger (below 50 years old)

move in to move on Co-morbidity commonplace, including mobility, oxygen-

dependency, chronic illnesses, ADL impairment, IADL impairment Buildings often include elevators HUD guidance on tenant preparedness not required

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Critical Issues----Personal Preparedness & Response Emergency Plan in place and shared with others

Personal support network in place

Plans for contacting needed others

Regular practice and plan revision

Pre-approval as volunteer for

CERT, MRC, K-HELPS, Red Cross

Awareness of community plans

Participation in community exercises

Easier Said than Done!!!

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Critical Issues----Shelter-in-Place? Decision to Shelter-in-Place or Evacuate

◦ Type of Disaster

◦ Safety of Staying vs Going

◦ Required Evacuation

Shelter-in-Place Plan ◦ Supplies and Equipment in place for 3-7 days

◦ Caregiving Support Available and Accessible

◦ Agreements for Supplies, Equipment, Services for home

Evacuation Plan Evacuation Kit—personal and car kits

◦ Know Who to notify,

◦ What is needed,

◦ When to go,

◦ Where to go, and

◦ How to get there

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Critical Issues---Agency Preparedness & Response

Risk Assessment HVA

Community Planning

Incident Command Training

Agency Preparation

Policies/Procedures for Caregivers on Staff

MOAs with Multiple Vendors

Staff Resources

Supplies Inventory

Shelter-in-Place Plan

Evacuation Plan

Direct Care Plan

Files/Contact Information

Continuity of Operations

Staff /Supervision

Timekeeping

Continued Payroll

Invoice Payment

Cash on Hand

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Critical Issues---Establish Mutual Aid Agreements At a minimum, mutual-aid agreements should include the following elements or provisions:

definitions of key terms used in the agreement

roles and responsibilities of individual parties

procedures for requesting and providing assistance

procedures, authorities, and rules for payment, reimbursement, and allocation of costs

notification procedures

protocols for interoperable communications

relationships with other agreements among jurisdictions

workers compensation

treatment of liability and immunity

recognition of qualifications and certifications

sharing of agreements, as required

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What Agencies Need to Know---State and Local Planning

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State and local governments:

• Must develop robust all-hazards plans and hazard- or incident-specific annexes with supporting procedures and protocols.

• Use hazard identification and risk assessment (HIRA).

What Agencies Need to Know---State Government Response: Key Players

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Title Responsibility

Public safety and welfare

Security issues: Liaison with other State & Fed. organizations

Hospital and Health Care Response Collaboration & support

Governor

Dept. for Public Health ESF #8 other State Department / Agency Heads

State Dept. for Homeland Security

Coordination of State response; Support to local governments

Director, State Emergency Management Agency

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KY Emergency Management

State Level — All States have laws which call for States to establish a State Emergency Management Agency and the Emergency Operations Plans for that state.

The Director of the Kentucky Division of Emergency Management has authority to represent the Governor in all matters related to a comprehensive emergency management program including manage the State Emergency Operations Center.

The Kentucky Division of Emergency Management is a division of the Kentucky Department of Military Affairs under KRS Chapter 30.

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Local Level: Emergency Manager Mayor/County Judge

Appoints local Emergency Manager (EOC)

--Local emergency manager can be full time, part

time, volunteer.

--Local emergency manager (county) has day-to-day

authority and responsibility for overseeing emergency management programs in that jurisdiction.

--Responsible for all matters involving a

comprehensive emergency management program

including the county Emergency Operations Plan and the Emergency Operations Center.

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Reasonable Expectations----Local Government: Preparedness is Key Incident Response Process

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Threat

Incident

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Reasonable Expectations----

Local Government: Local Roles

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Framework of Community Resilience (RAND Corp.)

Source:

L. Goldman, R Finkelstein, P Schafer, T Pugh: Resilient Communities: Empowering Older Adults in Disasters and Daily Life (June 2014)

Strategies for Community Resilience

KY Functional and Access Needs Collaborative Local and Regional Coalitions (FAN, HPP, LEPC) Use Block Watch groups Southern Utah—”Preparedness Buddy” National Council on Disabilities Area Agencies on Aging Alzheimer’s Association Key Advocacy Groups Dept. for Homeland Security

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Public Health Challenges of Community Resilience for Older Persons

Engagement in Neighborhoods

◦ Is the diversity of the neighborhood represented?

Neighborhood Leadership

Emergency Communication Methods—local 211 equivalent, Health Alert Network, TV/Radio

Engagement with Advocacy Groups—state and regional planning

◦ Are the right people around the table?

Retention

◦ How to keep them engaged

FAN Resources

https://dps.mn.gov/divisions/hsem/access-functional-needs/Documents/Functional%20Needs%20Planning%20Toolkit%20final%20(rev%205-13-13).pdf

http://www.fema.gov/pdf/about/odic/fnss_guidance.pdf

Moving Beyond ìSpecial Needsî: A Function Based Framework for Emergency Management and Planning. Kailes, J., Enders, A., (2007), Journal of Disability Policy Studies. PRO-ED, TX:Austin. 2007. 17: p. 230-237. Formats: PDF, Microsoft Word. Posted 12.26.09

Paradigm Shift in Planning for Special-Needs Populations. Parsons, B. and Fulmer, D. (2007), Emergency Management in Higher Education: Current Practices and Conversations; Papers from the 2007 FEMA Emergency Management Higher Education Conference. Microsoft Word Posted 12.26.09

Disaster Services and "Special Needs:" Term of Art or Meaningless Term? (PDF) Kailes, J. (2005), last accessed 01/17/08, Also published in International Association of Emergency Managers Bulletin, Special Focus Issue: Emergency Preparedness for Individuals With Disabilities, Part 2.

FAN Resources

http://develop.oes.ca.gov/WebPage/oeswebsite.nsf/Content/7CC19449AF7EEC028825748E0059F8BE?OpenDocument

http://www.jik.com/plancklst.pdf

HUD Portal

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More Information

Betty Shiels, PHD-C, LCSW, MSSW OVAR/GEC University of Louisville Kent School of Social Work (502) 852-8003 betty.shiels@louisville.edu

Funding through HRSA 2014-2015 grant #UB4HP19051 .